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Early warning criteria, Evaluation, Levels of care, Maternal, Perinatal, Pilot, Risk-based care



  1. Gillespie, Kate H. DNP, RN
  2. Chibuk, Amber MSN, BA, RN
  3. Doering, Jennifer PhD, RN
  4. Nelson, Ken III DNP, RN, NE-BC, CPHQ


Objective: The purpose of this study was to assess the influence of nursing care on implementing perinatal risk-appropriate care in the context of maternal early warning criteria.


Design: Medical record review and survey of maternity nurses in a three-hospital system in Wisconsin with two level I hospitals and 1 level III hospital.


Participants: Seven maternity nurses from the level III hospital conducted the medical record reviews and all maternity staff nurses from two level I hospitals were invited to complete the survey.


Measurements: All medical records in 2017 that met these inclusion criteria: hypertension, sepsis, preeclampsia, hemorrhage, low Apgar scores, and transport were reviewed to assess identification and response time for maternal early warning signs using the Nurses Contribution to Maternal Mortality Worksheet. The survey included questions about influences on the nurses' confidence when interpreting early warning indicators.


Results: Thirty-two medical records met inclusion criteria and were reviewed. The number of maternal early warning signs recorded ranged from one to four, with a mean of 1.75 indicators. Eighty percent of records documented increased evaluation as a nursing response to the maternal early warning signs. Time-lapse between notifying a provider and bedside evaluation was less than 15 minutes in 54% of cases. Of the 31 eligible nurses, 18 completed the survey (58% response rate). Personal knowledge (90%) was reported by nurses as being the greatest influence on nursing confidence. Sixty-nine percent of nurses reported not receiving patient information from team members at the transporting hospital.


Conclusion: A systematic record review by frontline nurses can monitor identification and response to maternal early warning signs. Feedback on patient transports can reinforce nurses' decision-making that has the potential to improve responsiveness to clinical warning signs.